Injury in the home is extremely common, accounting for approximately one-third of all injuries. [1] * The home is the second most common location of unintentional fatal injuries in the United States, with motor vehicles traveling on the road being the first. The home is the site of approximately 20% of all injury death. The top five leading causes of unintentional home injury death are falls, poisoning, fire/burn, choking/suffocation, and drowning; together these causes account for 90% of all unintentional home injury deaths. Yet the majority of unintentional home injuries do not result in death. For every home injury death there are approximately 650 nonfatal injuries. Children under age 5 and adults over age 70 are the highest risk groups for home injury, both fatal and nonfatal.

Morbidity and mortality

Death

Between 1992 and 1999, on average, there were nearly 20,000 unintentional home injury deaths per year.

The average annual death rate from unintentional home injury is 6.83 deaths per 100,000 persons.

The leading causes of unintentional home injury death between 1992 and 1999 were falls and poisonings, accounting for an average of 5,961 and 4,833 deaths each year respectively.

Older adults, both men and women, experience the highest rates of unintentional home injury death among all age groups, with those over the age of 80 years experiencing death rates more than 20 times greater than their younger counterparts.

Across all ages, males experience substantially more fatal unintentional home injuries than females (63% versus 37%).

Injuries and Emergency Department Visits

Between 1996 and 2000, an average of nearly 21 million medical visits were made each year due to home injuries.

Between 1997 and 2001, an average of 12 million nonfatal unintentional home injuries were reported each year, with falls accounting for the majority of the injuries (5.1 million).

The top five leading causes of nonfatal unintentional home injury are falls, struck by/against, cut/pierce, overexertion, and poisoning; these account for about 80% of all these injuries. Of these, falls account for 41.2% of all nonfatal unintentional home injuries.

Adults over age 70 and children ages 1-4 have the highest rates of nonfatal unintentional home injury.

Where deaths and injuries occur

Annual death rates due to unintentional home injury vary widely by state, with a four-fold difference between the state with the highest rate (New Mexico, 13.03 deaths per 100,000 persons) and the state with the lowest rate (Massachusetts, 3.33 deaths per 100,000 persons).

After New Mexico, Mississippi and Arizona have the second and third highest rates, exceeding the national average by 38% and 33% respectively. After Massachusetts, Utah and Maryland have the lowest rates with annual average rates of 42% and 36% lower than the national average respectively.

While the leading causes of death are similar across the nation, there are some regional differences. For example, Southeastern states have high death rates from residential fires compared to other regions, perhaps due to type of home heating, type of home construction and the prevalence of manufactured homes. Rates of drowning death are highest in Florida, Arizona, Nevada, and California where climates are warmer and swimming pools may be more common.

Populations at disproportionate risk

Children

An average of 2,096 children younger than 15 die each year as a result of an unintentional home injury. The top five leading causes of unintentional home injury death in this age group are fire/burn, choking/suffocation, drowning/submersion, firearm, and poisoning.

Children under the age of 1 have the highest rate of death (12.19 per 100,000 children less than a year old). The rate decreases with increasing age: age 1-4 (6.42 deaths per 100,000 children of same age), age 5-9 (1.85 deaths per 100,000 children of same age) and age 10-14 (1.47 deaths per 100,000 children of same age).

Children younger than age 15 years experience an average of more than 3 million nonfatal unintentional home injuries every year. Falls are the leading cause of nonfatal home injuries across all childhood age groups, accounting for nearly 1.3 million injuries each year.

Older Adults

Each year, an average of more than 7,000 adults age 65 and older die from unintentional home injuries. The top five leading causes of these home injury deaths are falls, fire/burn, poisoning, natural/environmental (e.g., exposure to severe heat or cold or a natural disaster), and choking/suffocation.

Falls alone account for 52.5% of all home injury deaths for adults age 65-74, 68.2% of home injury deaths for adults age 75-84, and 78.4% of home injury deaths for adults age 85 and older.

Adults age 65 and older experience an average of 2.3 million nonfatal unintentional home injuries annually. The top five leading causes of these nonfatal injuries are falls, overexertion, struck by/against, cut/pierce, and poisoning. Again, falls are the leading cause, accounting for more than 66% of nonfatal home injuries.

Individuals with Disabilities

An estimated 20% of adults and children in the United States live with at least one disability [1]; however, little is known about home safety practices in households where an individual with a disability resides.

The risk of fatality from residential fires is higher when persons with physical or mental disabilities are present [2-3].

Households in the United States in which a person with a disability resides are less likely than homes without a disabled resident to have stairs without handrails or banisters and to have a fire escape plan [4].

Households in the United States with a disabled resident are more likely to have handrails or grab bars in a bathroom, have mats or non-skid strips in a tub/shower, and to be aware of the temperature setting on the hot water heater, compared with homes without a disabled resident [4].

Cost and cost-effectiveness data

Unintentional home injuries cost society at least $222 billion per year in medial costs, with an additional $165 billion in medical costs from injuries that possibly occur in the home.

The top five causes of unintentional home injury by cost are falls, struck by/against, poisoning, cut/pierce, and overexertion. Falls alone cost an average of $100 million annually and cost 5 times more than the next highest cause of home injury.

Interventions

Multi-factorial injury prevention interventions have been shown to reduce injuries in the home. [5]

There is insufficient evidence from trials to show that physical adaptations to the home environment alone reduce the number of injuries in the home. [5]

References

1. Carmona, R.H. and J. McCabe. Improving the health and wellness of persons with disabilities: a call to action. American Journal of Public Health, 2005. 95: p. 1883.